Posted on 02/28/2014 at 02:52:32 PM by Student BloggerBy Sabrina Sales Martinez, MS, RDN
In a blog article I wrote for ASN last year titled “AMA Declares Obesity a Disease. Should we LIKE this decision?” I discussed the announcement by the American Medical Association (AMA) on classifying obesity as a “disease.” In the body of that blog, I discussed some potential pros and cons of this decision. The potential beneficial effects may include greater treatment, research and prevention endeavors. There were concerns, however, about using BMI to diagnose obesity, believing that obesity needed to be treated only with medication or surgery, and creating deterministic attitudes by which the obese person, believing that he or she is ill, feels without control over the disease.
The effect of this policy on the epidemic of obesity and on its prevention and treatment are yet to be known. Researchers at the University of Richmond and University of Minnesota, however, have found some interesting results on the psychological aspects of the AMA's declaration.
Hoyt et al. studied whether the AMA's message affected concerns about weight and body image and motivation to participate in healthy behaviors. Experimental studies were conducted using 727 participants from Amazon's Mechanical Turk, a crowdsourcing internet marketplace, in which individuals can perform tasks for a modest payment. Participants were asked to read either an article on the AMA's decision to classify obesity as a disease, a standard public health article on weight, or an article on why obesity is not a disease. After reading the assigned article, the participants responded to questions on self-regulatory processes, body dissatisfaction, food choices, demographics, and height and weight. The outcomes showed that those who were obese and read the article on obesity as a disease had less concern about their weight and body dissatisfaction than those who read the public health article or the article that maintained that obesity is not a disease. Additionally, those who were obese and read the obesity is a disease article chose the higher calorie food options.
These investigators state that their research demonstrates the benefits and hidden consequences that come from the message that “obesity is a disease” and this message may increase satisfaction with body image but may interfere with self-regulatory processes in those who are obese. Higher body satisfaction in the obese participants predicted higher calorie food choices. The authors also discussed that even moderate weight loss in obese individuals may have positive health implications and that this may not occur if the obese person harbors less concern about weight. The conclusions of this research opened the door for a discussion on the AMA's decision.
The authors of the above mentioned article attempted to stimulate new research questions about future public health related obesity messages using scientifically based evidence. This study did have limitations, which included the calculation of BMI using self-reported height and weight, which may not be accurate. In addition, socio-demographics and levels of education were not included or discussed and the study mainly focused on weight and not on other aspects of health such as exercise.
In summary, the public health message that identifies obesity as a disease may have effects on self-regulatory mental and physical processes that may affect weight. This same message also appeared to have palliative effects on alleviating stigma for those who were obese. Certainly this study is creating a discussion, and raising doubts, on whether labeling obesity as a disease would be an important or a counter-productive tactic on combating obesity. As mentioned in my previous blog article, as an optimist, I am confident that the attention brought by the AMA's decision has a beneficial impact on prevention and treatment efforts for obesity, and that it will make treatment of obesity an essential component in an individual's healthcare. However, we cannot ignore that there are hidden, maybe unintended, consequences from this message.
1. American Medical Association (AMA). AMA Adopts New Policies on Second Day of Voting at Annual Meeting. Available at: http://www.ama-assn.org/ama/pub/news/news/2013/2013-06-18-new-ama-policies-annual-meeting.page.
2. Hoyt CL, Burnette JL, Auster-Gussman L. "Obesity Is a Disease": Examining the Self-Regulatory Impact of This Public-Health Message. Psychol Sci. 2014 Jan 24. doi:10.1177/0956797613516981
3. Buhrmester M, Kwang T, Gosling SD. Amazon's Mechanical Turk: A new source of inexpensive, yet high quality, data? Pers Psychol Sci. 2011. 6, 3–5.